HERBS

ASCITES

ABOUT THE DISEASE

Ascites is accumulation of excessive amount of fluid within the abdominal cavity.

Clinically, Ascites is detectable when more than 500 ml of fluid accumulates in the abdominal cavity.

CAUSES

The most common causes leading to Ascites are:-

  • Liver diseases like Liver cirrhosis, liver cancer, Budd chiari syndrome, Extensive fatty liver.
  • Cardiovascular disease like Congestive Heart Failure.

Other less common causes includes:-

  • Malnutrition.
  • Renal disorders (Like – Nephrotic syndrome).
  • Intestinal TB.
  • Vasculitis.

PATHOGENESIS

The main mechanism behind accumulation of water in the peritoneum is due to increased pressure (Hydrostatic pressure) in the capillaries and reduced pressure (Oncotic pressure) in the plasma along with fluid and salt retention by the kidneys.

The ascitic fluid can be of two types 1) Transudate or 2) Exudate

1. Transudate fluid is more watery with protein content less than 3gm/dl and specific gravity 1.010. This is more common.

2. Exudate fluid is heavy with protein content more than 3gm/dl, specific gravity more than 1.010 and may contain pus cells, more white blood cells or blood cells. It is generally found in diseases pertaining to inflammation of organs or Tuberculous infections or in cancerous conditions.

SIGNS AND SYMPTOMS

It includes:-
  • Feeling of Abdominal fullness or heaviness.
  • Abdominal distension, Degree of distension depends upon the amount of fluid accumulated. Small amounts may go even unnoticed.
  • Swelling in both feet.
  • Breathlessness on mild physical exertion like walking or talking.
  • Fatigue.

Other signs and symptoms may depend upon the disease involved.

Ascites is first detected clinically by examination of abdomen by doctor and afterwards confirmed through laboratory investigations.

AYURVEDIC VIEW

In Ayurveda, the presentation of distended abdomen has been mentioned as a disease called “Udara” Roga. Various types of Udara Roga have been mentioned by Acharyas which are according to the causative factors.

The distension of abdomen caused due to accumulation of fluid has been termed as “Jalodara” Roga. “Jala” means water and “Udara” means distended abdomen.

Causes
  • Intake of very salty, sour, dry, spicy, unhygienic, alkaline or acidic diet.
  • Chronic poisoning.
  • Not following proper diet and lifestyle post Panchkarma therapy.
  • Holding of natural urges of the body.
  • Practising intake of incompatible diet for eg:- intake of milk and fish together, intake of sweet and sour fruits together etc.
  • Intake of cold water immediately after ghee or oily food or due to improperly done Snehana therapy.

PATHOGENESIS

The causative factors mentioned earlier lead to Agnimandya (Low metabolism) aggravation of three Doshas. This leads to Aam formation and obstruction of channels (Srotasas) and create accumulation of Rasa (plasma) in the abdominal cavity leading to jalodara (Ascites).

CLINICAL FEATURES

It includes:-
  • Abdominal distension – The abdominal distension first appears in umbilicus and slowly moves upwards.
  • Anorexia.
  • Excessive thirst.
  • Serous discharge from anal route.
  • Abdominal pain.
  • Difficulty in breathing.
  • Cough.
  • Weakness.
  • Visible veins and lines over abdomen.
  • Fluid thrill on tapping the flank of abdomen.
  • Everted umbilicus.
  • Production of sound like emptying of vessel (shifting dullness).
  • Palpitation.
  • Difficulty in walking.

Based on the symptoms, Acharyas have classified Ascites in to three grades:-

1. This is the starting stage in which there is either no or very less accumulation of fluid in the abdomen. No complications are present.

2. Second stage called as “Pichha awastha” – In this there is accumulation of viscous frothy fluid in the abdominal cavity. Abdomen appears round with heaviness and stiffness. On percussion there is a dull note.

3. The third stage is final stage which is called as “Jatodaka” which means appearance of fluid. In this stage, abdomen is distended to a much larger extent. Veins are not visible on skin over the abdomen and skin appears very shiny, Fluid thrill test is positive. Complications can also occur in this stage.

PRINCIPLE OF TREATMENT

The principle of treatment for “Udara Roga” is correction of impaired Agni (Metabolism) and Deepana Pachana karma. Srotoshodhana treatment for clearing the blockages of channels should also be given which will clear the blockages and stop further accumulation of the fluid.

The disease causing Ascites should also be treated.

MEDICINES

1. Single herbs – Rohitaka (Tecoma undulata), Bhumyamalki (Phyllanthus niruri), Daruhaldi (Berberis aristata), Kutki (Picrorhiza kurroa), Nagarmotha (cyperus rotundus), Indravaruni (Citrullus colocynthis), Pippali (Piper longum), Giloy (Tinospora cordifolia), Neem (Azadirachta indica), Mahanimba (Melia azedarach), Chirayta (Swertia chirata), Patola (Trichosanthes dioca), Punarnava (Boerhavia diffusa).

2. Herbal Powders – Narayan churna, Kushthadi churna, Patoladi churna, Punarnavadi churna, Rohitakadi churna, Hapushadi churna, Aarogyavardhini vati, Agnitundi vati, Kshar vati.

3. Ras Aushadhi (Herbo Mineral preparations) – Jalodarari Rasa, Ichhabhedi Rasa, Narach Rasa, Punarnava Mandoor, Yakritplihari Lauha.

4. Kwath (Decoctions) – Punarnavadi kwaath, Dashmooladi kwaath, punarnavashtak kwaath, Phaltrikadi kwaath.

5. Asava/Arishta (Alcohol Preparations) – Dashmoolarishta, Punarnavarishta.

6. Panchkarma Procedures like Virechana and Basti are very useful for removing collected fluid in the abdomen.

7. Acharya have mentioned tapping of fluid in case of large amounts of fluid accumulation or third stage of Ascites.

HOME REMEDIES

1. Eat light, semi solid and easily digestible food. Avoid starchy,oily and refined food items.

2. Take foods which are naturally diuretic in nature like raisins, pineapple, horse gram, oranges, grapes etc.

3. Be physically active and do not sleep in day time.

4. Limit water intake to 1-1.5 litres /day.

5. Limit use of salt to 1.5 gm/day.

6. 1 glass of Karela juice (Bitter gourd) daily intake helps in improving digestion and flushing out toxins from the body.

7. Daily intake of 1 glass of fresh juice of Radish helps in Ascites caused due to liver disorders.

8. Take 1 glass of fresh buttermilk mixed with ½ teaspoon cumin powder , ½ teaspoon ginger powder and mint leaves. This helps in improving digestion and will help in reducing abdominal heaviness.

9. Take equal quantities of dried ginger powder, dried long pepper powder and black pepper powder. Intake of ½ teaspoon of this mixture along with goat’s milk or camel’s milk regularly helps in stopping fluid accumulation in the body and improves the metabolism of the body. It also improves electrolyte balance in the body.

10. ½ teaspoon Dried ginger powder mixed with cow’s milk helps in indigestion, low appetite and flatulence.

11. If suffering from constipation take 1 teaspoon of harad powder with luke warm water or 10 ml castor oil with milk at night.

Disclaimer

The purpose of Ayurvidya is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider regarding your medical condition or treatment and before undertaking any new health care regimen.